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This effect was previously documented in the DCCT and UKPDS trials and occurs regardless of the treatment method used (insulin, oral agents, or GLP-1 medications), reflecting changes in retinal blood flow and vascular permeability during metabolic adjustment

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The quality of available evidence is further limited by methodological concerns, including small sample sizes, short study durations, lack of standardisation in probiotic formulations, and potential publication bias favouring positive results